Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen.
All patient vignettes are confabulated; the psychiatrists, however, are mostly real.
--Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask. (It's not Shrink Wrap.)

Sunday, December 30, 2007

Happy New Year, everyone! As 2008 approaches, Roy, ClinkShrink and I will be meeting today (with the new & improved sound equipment) to record a podcast, and then I'm off to sip champagne on a warm and sunny beach. My friends, I trust, will hold the blog fort up.

So the other day, one of my kids asked me if I'd drive a bit and pick up one of their camp friends to spend the night. This child lives a fair distance and I've met only once, at a mall, when the two kids wanted to spend a little time together. This request was for me to pick the kid up, bring her home, and have her spend the night. A stranger to me, but a fellow camper to my child.

Some of my kids' friends see therapists and psychiatrists and take psychotropic medications. Some aren't so quiet it about it, I can be driving in a car and someone will pop out with "That's the building where my psychiatrist works!" Okay. But if they take medications while they're sleeping over my house, then I guess they do so quietly, no one's ever asked my assistance with any medication before. And a few, well, as they're jumping off my furniture in back flips, I just Know they must be taking Ritalin or something like it to get through the school day.

So I pick up the unknown camp kid and her mother hands me a bag of medications. I don't know mom, and I don't know the kid, and I don't imagine they know I'm a psychiatrist. "The instructions are on the bottles." Okay, I can do this.

The visit was uneventful, the child is lovely, patient with my kid who enlisted her help on an hours-long school project from Hell (don't ask, but if you're handy with a drill and have nothing better to do this afternoon, we could use your help here). As I handed the visitor her third mood stabilizer, I asked, "Do you feel differently if you don't take this?" "Not right away," she said.--------------------------------------------------And from today's Sunday New York Times Magazine and the recap of this year's The Lives They Lived Issue and some thoughts on mental illness:

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comments:

So she'd be in her mid-teens? Why does she need you to dole out her meds? I'm thinking that if I'd thought this through I'd be saying something like 'If your daughter isn't mature enough to take her own pills she probably isn't mature enough for a sleepover.' Or something. Or is she not allowed to handle her own meds because she's on suicide watch?

I'm ambivalent about treating mood disorders with medication in teenagers. Depression is so dangerous in young people partly because they're impulsive but partly because they haven't yet figured out that it's depression and that they'll survive it. If you're never permitted to struggle through it, how will you ever learn that you can?

I say this as someone who showed signs of mood disorder from at least ten, who had her first suicidal episode (no attempts, but a huge amount of brooding) at fourteen, and who was never able to graduate from college. I'd cycle between glowing, ambitious enthusiasm and depression that had me shut in my room instead of taking exams. (Also I've had classmates who attempted or committed suicide in high school - one of whom also committed murder.) So I know that untreated mood disorder can exact a high price, and not just from the individual.

But I also treasure my hard-earned sense of self-reliance. I take my meds because they help me get where I want to go, but my depression is my own. Meds are only one tool I use, and I can tell the difference between sadness, depression, and my life being in immediate danger.

The people I know who started meds as teens seem much more messed-up to me. Less self-reliant, more self-absorbed.

Alison, your comment about maturity made me think of having to go to the nurse every day for my allergy pills when I went to nerd camp in junior high. I've been in charge of my own pills (up to six different prescriptions a day) since I was six or seven. I was so insulted at twelve to have to surrender them for three weeks to a camp nurse... and at a camp for smart kids, no less!

Had you told the mother you are a psychiatrist, I'm thinking you could have billed for: 1) medication management, and 2) by asking if she "feels differently," a brief therapy session. Then again, you don't accept insurance or fill out forms...

gingerb---it is like art.everything is worth a lot once the artist is dead. The nyt is the nyt.it is kind of moma so look at it like that and like everyone else pretend it holds great meaning.and write a book while u can so u can be famous after death and no one can question u.